What is Biliary Tract Cancer?

Cancer is the uncontrolled division of abnormal cells. Biliary tract cancer arises anywhere in the biliary system, which comprises the liver, pancreas, bile ducts and gallbladder.

Bile is a dark-green to the yellowish-brown fluid secreted by the liver. The gallbladder is a small organ nestled below the liver that stores bile. The bile duct carries bile from the gallbladder to the small intestine to facilitate fat-digestion.

Types of Biliary Tract Cancer

Cancer of the biliary tract is named after the organ or duct where it initially begins. Two important types are:

Cholangiocarcinoma: Cancer of the bile duct; can be of the following types:
Intrahepatic: Tumour arises from the bile ducts within the liver
Hilar: Tumour begins in the bile ducts that lie outside the liver
Distal: Tumour begins in the bile duct that is close to the small intestine
Multifocal: Multiple tumours arise from different regions of the bile duct
Gallbladder Carcinoma: Cancer arises from the tissues of the gallbladder.

Stages of Biliary Tract Cancer

Stage I: Tumour arises in the inner layers of the bile duct or the gallbladder
Stage II: Tumour spreads to the wall of the bile duct or the gallbladder
Stage III: Cancer has spread to hepatic duct, liver, nearby lymph nodes and blood vessels
Stage IV: Cancer has migrated to distant organs

Symptoms

The symptoms of biliary tract cancer include:

Yellowing of the eyes and skin (jaundice)
Itchy skin
Abdominal pain
Fever and chills
Nausea and vomiting
Loss of appetite
Unusual weight loss
Dark urine

Risk Factors

The common risk factors that can cause biliary tract cancer include:

Advanced age
Gallstones
Smoking
Obesity
Diabetes
Ulcerative colitis
Cysts in the bile duct
Liver fluke parasite infection
Family history of the gall bladder or bile duct cancer

Diagnosis

Your doctor will assess your symptoms and perform a physical exam. The following diagnostic tests or procedures may be ordered:

Liver Function Test (LFT): Determines the health of your liver, gallbladder and bile ducts
Imaging Tests: Images of your gallbladder and bile ducts are obtained by performing a CT scan, MRI or ultrasound.
Endoscopic Retrograde Cholangiography (ERCP): An endoscope is inserted into your mouth and advanced towards the stomach and duodenum (the first part of the small intestine). A dye is injected and X-ray images are taken to study the stage of gallbladder or bile duct cancer.
Biopsy: A small piece of suspect tissue is obtained and observed under the microscope for the presence of cancerous cells.

Treatment

Treatment depends on the stage of biliary tract cancer and can involve one or more of the following treatment options:

Chemotherapy

The use of drugs to treat gallbladder or bile duct cancer. The drugs may be pills or intravenous injections.

Radiation Therapy

High-energy particles or waves such as X-rays and gamma rays are used to kill or damage cancerous cells.

Targeted Cell Therapy

This involves the use of drugs that specifically target certain proteins in cancer cells to destroy them, but does not damage the other cells of the body.

Biological Therapy

A healthy immune system is necessary to fight cancerous cells. Biological therapy involves administering interleukins or interferons (types of proteins) to naturally defend your body against cancerous cells.

Cholecystectomy

Cholecystectomy is the surgical removal of the gallbladder, which is a safe treatment for gallbladder cancer. The surgery is performed by an open-surgery method or laparoscopically. Laparoscopy is a minimally-invasive surgical procedure that uses a laparoscope to diagnose and treat various disorders. A laparoscope is a thin fibre-optic device fitted with a camera and lens. Images from the camera are transmitted to a monitor for your doctor to view the inside of your body.

Surgery to Remove Bile Duct Cancer

Surgical removal of bile duct cancer is a major surgery that involves removing the bile duct containing the tumour, as well as part of the liver, gallbladder or pancreas. One or more nearby lymph nodes also may be removed. The surgery is usually performed under general anaesthesia by an open-surgery method. You may be given chemotherapy or radiation therapy to kill any cancer cells left after surgery.

Biliary Tract Cancer